Continence for Young Adults
Prevalence and Challenges Faced by Young Adults with Incontinence

Overview

This can have significant psychological impacts, leading to academic under-achievement, poorer self-image, and challenges in peer relationships⁵.

Facts about Incontinence in Adolescents

• Reported incontinence prevalence rates in adolescents and young adults vary from 3% to 4% for urinary incontinence, and around 1% for faecal incontinence ⁵
• The risk of incontinence will increase with developmental, neurological, and anatomical anomalies, which may be present at birth or acquired in childhood ¹
• Behavioural factors can also impact on bladder and bowel function, such as diet, fluid type and intake, withholding, or poor toileting behaviours

Urinary Incontinence

Wetting the bed, called nocturnal enuresis, is quite common in childhood. If children who wet the bed are left without treatment, nocturnal enuresis can carry on into adolescence and early adulthood. Nocturnal enuresis can occur due to several different causes, including:

• Deep sleep—not waking with the urge to urinate. This could be due to a sleep disorder, or attributed to the sedating effects from medication, alcohol, or illicit drugs.
• Large volumes of urine—for some people, their kidneys work overtime at night and produce more urine than the bladder can hold, resulting in accidents.
• Small bladder capacity—a person might have a bladder that cannot expand to hold much urine, or experience symptoms of overactive bladder, whereby the bladder contracts frequently and without warning. Being constipated, consuming too much caffeine, or having a urinary tract infection can also cause symptoms of overactive bladder.

What is Nocturnal Enuresis?

Faecal Incontinence

• Gastrointestinal disorders and dietary intolerances that result in frequent and urgent episodes of diarrhoea, leading to loss of control
• Damage to the muscles and nerves that control bowel function. This could occur because of neurological conditions, injury and trauma, long term constipation, or through giving birth.
• Medications that cause diarrhoea, like laxatives or antibiotics, may contribute to faecal incontinence
• Congenital and developmental disorders can lead to difficulties in bowel control, such as spina bifida and anorectal malformation
• Psychological and behavioural factors can contribute to bowel disfunction. This could include high levels of stress and anxiety. Eating disorders, such as anorexia and bulimia, can also disrupt gastrointestinal function.

Treatment

How can you address both urinary and faecal incontinence?

• This could include improving your diet and avoiding or minimising certain foods or fluid.
• Improving hydration and incorporating healthy bladder and bowel habits.
• Pelvic floor muscle exercises done regularly will also help improve control, while exercise that strains the pelvic floor should be avoided.
• For nocturnal enuresis, a temporary alarm system might be recommended to help teach your body to wake with the urge to void, which can often resolve night wetting altogether.

If these conservative measures fail to improve your continence, medications may be recommended for treatment of some bladder and bowel complaints.

What to consider when a conservative measure to improve continence and overactive bladder fails:

• For bowel issues, medications may be recommended to treat either constipation or diarrhoea or target the underlying gastrointestinal issue contributing to incontinence.
• Medications may be prescribed for an overactive bladder to help the bladder relax and hold more urine. In some cases, Botox injections into the bladder can further help the bladder relax and resolve symptoms.
• Nocturnal urine production can be reduced with prescribed medication if this is causing night wetting.
• Medication might be required in the short term or the long term and some of these medications can have side effects, so it is important to ask your prescribing healthcare professional about duration and possible side effects.
• In severe cases, surgery may be suggested to restore continence. Surgery is usually recommended after all other options have been explored.

If continence cannot be restored or an individual chooses not to undergo invasive procedures, there are multiple management strategies available.

What are some continence management strategies?

• Absorbent continence aids come in both disposable and washable options, in the form of pads, pants, furniture protectors, and bed clothes.
• Portable urinals, easy access clothing, and environmental modifications can all make living with incontinence much easier, while maintaining dignity and social engagement.
• Funding for continence supplies is also available through insurance schemes or government subsidies to relieve the financial burden of living with incontinence.

Good Bladder and Bowel Habits for Everyone

• Minimise carbonated, caffeinated, and alcoholic drinks, as these can be bladder irritants.
• Maintain adequate hydration. Do not restrict drinking in an attempt to minimise leakage.
• Eat a healthy balanced diet with plenty of fruits, vegetables and whole grains.
• Position yourself comfortably on the toilet, lean forward with feet apart and knees bent.
• Ensure you fully empty your bladder or bowel when going to the toilet and do not rush.
• Try not to use the toilet ‘just in case’ and avoid straining when opening your bowels.
• Regular pelvic floor muscle exercises can help strengthen the muscles responsible for bladder and bowel control.

If you experienced frequent episodes of urinary of faecal incontinence, speak to a healthcare provider or call the Continence Foundation of Australia Helpline on 1800 33 00 66. Remember that early diagnosis and treatment are essential to prevent the condition from worsening and to maintain quality of life.